Adjustable knotless loops

ABSTRACT

Methods of attaching a soft tissue to an adjacent bone at a defect site are provided. An adjustable loop region of a flexible construct contained in a bore defined by a fastener is passed through a tissue. The adjustable loop is passed through the tissue. The fastener is passed back through the adjustable loop to fold the adjustable loop upon itself. The fastener is attached to the bone. An adjusting arm on the flexible construct is engaged to reduce the size of the adjustable loop and secure the soft tissue to the bone.

FIELD

The present disclosure relates to methods and apparatuses for securing aflexible construct. In particular, the present disclosure relates tosecuring a flexible construct with an adjustable loop.

BACKGROUND

The statements in this section merely provide background informationrelated to the present disclosure and may not constitute prior art.

Surgical procedures are often performed on a body, for example, a humanbody or anatomy, to repair or replace various portions thereof. Forexample, the soft tissues of the body may need to be reattached to bonesdue to trauma, overuse, surgical intervention, or disease.

Soft tissues can be reattached to bone using fastening devices such asscrews, staples, and various types of suture anchors. Soft tissues areoften fixed to various positions on the bone. For example, to replace anatural tendon fixation point or to replace the tendon itself, fixing agraft to a selected bone area may be desired. One means to fix a softtissue to the selected area is to provide a suture through a selectedportion of the soft tissue and fix the other end of the suture to aselected area on the bone with the fastener. To secure the sutures, thefree ends of the suture are tied together to form a knot.

The use of knots in surgical procedures, however, can be improved upon.In minimally invasive procedures, such as arthroscopic or laparoscopicprocedures, the surgical site is not readily accessible and limits thesurgeon's ability to tie a knot manually. One remote method of securingthe suture is tying each of the suture ends into a knot extracorporeallyand then remotely advancing the knot into the surgical site usingsuitably configured instruments. Securing the suture remotely can becumbersome and time-consuming.

Accordingly, there is a need for improved devices for securing a suturewithout a knot. There is a need for surgical methods to facilitate easyand efficient securing of the suture.

SUMMARY

The present teachings provide methods of attaching a soft tissue to anadjacent bone at a defect site. An adjustable loop of a flexibleconstruct contained in a bore defined by a fastener is passed throughthe soft tissue. The fastener is passed back through the adjustable loopto fold the adjustable loop upon itself. The fastener is attached to thebone. An adjusting arm on the flexible construct is engaged to reducethe size of the adjustable loop and secure the soft tissue to the bone.

The present teachings also provide methods of repairing a cartilagedefect. An adjustable loop of a flexible construct is offset through abore defined by a fastener. The adjustable loop is secured to a proximalend of the fastener with a restriction element. The adjustable loop ispassed through the cartilage. The fastener is passed back through theadjustable loop to fold the adjustable loop upon itself. The fastener isfixed to an area adjacent the cartilage defect such that the adjustableloop and a proximal end of the fastener abut the cartilage defect. Anadjusting arm on the flexible construct is engaged to reduce the size ofthe adjustable loop and secure the soft tissue to the bone.

The present teachings further provide methods of attaching a soft tissueto an adjacent bone at a defect site. An adjustable loop of a firstflexible construct contained in a bore defined by a first fastener ispassed through a tissue. The first fastener is then attached to thebone. A second fastener having a second adjustable loop of a secondflexible construct passed through a bore therein is passed through thefirst adjustable loop on the first fastener. The second fastener ispassed back through the first adjustable loop to interlace the firstadjustable loop and the second adjustable loop.

Further areas of applicability will become apparent from the descriptionprovided herein. It should be understood that the description andspecific examples are intended for purposes of illustration only and arenot intended to limit the scope of the present disclosure.

DRAWINGS

The drawings described herein are for illustration purposes only and arenot intended to limit the scope of the present disclosure in any way.

FIG. 1 depicts a flexible construct according to various embodiments;

FIG. 2 depicts a fully extended flexible construct according to variousembodiments;

FIGS. 3A and 3B depict movement of the adjustable loop according tovarious embodiments;

FIG. 4 depicts an assembly of an adjustable loop disposed about a sutureanchor according to various embodiments;

FIG. 5 depicts a cross-section of the assembly of FIG. 4;

FIG. 6 depicts the adjustable loop disposed about a suture anchor andattached to a driver according to various embodiments;

FIG. 7 depicts an exploded view of the assembly of FIG. 6;

FIGS. 8A through 8E depict a surgical technique according to variousembodiments; and

FIGS. 9A through 9D depict a surgical technique using two flexibleconstructs according to various embodiments.

DETAILED DESCRIPTION

The following description is merely exemplary in nature and is notintended to limit the present disclosure, application, or uses. Althoughcertain examples and surgical methods disclosed herein are inconjunction with a suture anchor, it is understood that the suturefixation device can be any device with which to hold a suture. While thepresent teachings are disclosed in connection with labral repairs, it isunderstood that the devices and surgical techniques can easily beadapted for other orthopedic and non-orthopedic uses.

Referring to FIGS. 1 through 3B, the flexible construct 10 includes anadjustable loop 12, a passage 14, and an adjusting arm 16. Reduction ofthe adjustable loop 12 compresses the tissue and provides fixation ofthe tissue. The adjustable loop 12 and the surgical methods detailedherein, eliminate the need to tie a knot and thereby increase surgicalefficiency. As compared to traditional sutures secured by tying a knot,the flexible construct 10 of various embodiments provides increased loadto failure, has multiple-fold increased strength, has a decreasedstretch at failure, and has multiple-fold stiffness at failure.

Referring to FIG. 2, the flexible construct 10 can be made from anybiocompatible material that is flexible and can pass through and securea tissue. Exemplary materials include, but are not limited to,non-resorbable polymers, such as polyethylene or polyester, resorbablepolymers, metals, and various combinations thereof. The materials caninclude those formed into a monofilament, multiple filaments, cables,and the like. In various embodiments, the flexible construct 10 is madeof a hollow material to allow for the appropriate folding and tensioningthereon.

In various embodiments, the flexible construct 10 can be a suture 18.The suture 18 used to form the construct is generally a hollow suturehaving a distal end 20 and proximal end 22. The suture 18 can be formedas a braided or multiple-filament suture structure that is formed todefine a substantially tubular hollow-shaped flexible construct 10.

The suture 18 contains a first opening 24 located closer to the distalend 20 and the second opening 26 located closer to the proximal end 22.In various embodiments, the first opening 24 and the second opening 26can extend along a top surface of the suture 18 and are sized toaccommodate passage of the distal end 20 of the suture therethrough. Itis understood that the first opening 24 and the second opening 26 neednot be formed by cutting the suture 18 or by removing any suturematerial. For example, the first opening 24 or the second opening 26 canbe formed by passing the suture distal end 20 through the sidewall ofthe hollow tubular suture 18.

The passage 14 is defined by the area between the first opening 24 andthe second opening 26. The passage 14 can be a short passage, can extendto the length of a fastener used therewith, or have a greater length, asfurther detailed later herein.

To provide the adjustable loop 12 and the adjusting arm 16, the distalend 20 of the suture 18 is passed through the first opening 24, into andthrough the passage 14, and advanced out of the second opening 26. Theportion exiting from the second opening 26 provides the adjusting arm 16and the folded end provides the adjustable loop 12.

Other adjustable loops that are useful in the various embodimentsdetailed herein are disclosed in U.S. patent application Ser. No.11/541,506 to Stone, filed Sep. 29, 2006, and assigned to Biomet SportsMedicine, Inc., which is hereby incorporated by reference.

Referring to FIGS. 3A and 3B, the adjusting arm 16 is engaged or pulledin direction A to cause movement of the adjustable loop 12. As theadjustable loop 12 is reduced in size (or creating a smaller diameterloop 12), the adjusting arm 16 lengthens as shown in FIG. 3B, In variousembodiments, the movement of the suture 18 is only in the direction ofarrow A and movement is prevented in the opposite direction. Thisunidirectional movement is controlled by maintaining tension (bypulling, for example) on the flexible construct 10 to radially compressthe passage 14 about the suture portion contained therein as furtherdetailed later herein.

To facilitate the unidirectional movement, a restriction element 28 canbe included near the proximal end 22. The restriction element 28controls movement of the adjustable loop 12 and the adjusting arm 16.Moreover, the restriction element 28 can prevent displacement of theflexible construct 10 in minimally invasive procedures. As depicted, therestriction element 28 is a knot. It is understood that the restrictionelement 28 does not provide the tissue fixation, but it is the tissuecompression provided by the reduction of the adjustable loop 12 aboutthe tissue that provides the fixation. The restriction element 28 caninclude other devices used to retain a suture, such as a suture clip.

The flexible construct 10 can be attached to a fastener to create anassembly. As shown in FIGS. 4 and 5, an asymmetric suture anchor 100 isused as the fastener. The asymmetric suture anchor 100 is similar toanchors described in U.S. patent application Ser. No. 11/386,068 toStone et al., filed Mar. 21, 2006, and assigned to Biomet SportsMedicine, Inc., which is hereby incorporated by reference.

The asymmetric suture anchor 100 includes a tip 102, an anchor body 104having an interior bore 106, an exterior suture-receiving channel 108defined by one side of the anchor body, and a port 110 connecting theinterior bore 106 and the exterior suture-receiving channel 108. Theanchor can be made of any biocompatible material including, but notlimited to, a metal, such as titanium, stainless steel, or alloys ofcobalt, chromium, etc., or a polymer such as polyetheretherketone (PEEK)or polymers and copolymers of lactic and glycolic acid.

At the distal end of anchor 100, the tip 102 is adapted to substantiallyease entry of the asymmetric suture anchor 100 into the bone portion.The tip 102 can be generally smooth or rounded as shown in FIGS. 4 and5, or the tip 102 can be pointed as shown in FIGS. 6-9D. The tip 102guides the anchor 100 such that the anchor 100 can be placed into apre-drilled hole in a honey tissue to reattach a soft tissue theretowithout damaging the soft tissue. In various embodiments, the asymmetricsuture anchor 100 can be rotated or twisted upon insertion into thepre-drilled hole to align and set the asymmetric suture anchor 100 priorto completely advancing the anchor 100 to its final position.

Attached to the tip 102 is the anchor body 104. The anchor body 104 canbe externally threaded or have helical or annular ribs. The threadingcan be a helical thread which starts at the meeting point of the tip 102and the anchor body 104 as shown in threads 112. The threads 112facilitate engagement of the tissue by the asymmetric suture anchor 100.

A bore 106 in the anchor body 104 extends from a proximal end of theanchor body 104 through an interior portion of the anchor body. The bore106 generally extends along the longitudinal axis of the anchor body 104and is open at the proximal end. The bore 106 can be offset with theouter diameter of the anchor body or the bore 106 can be concentric withthe outer diameter of the anchor body. The bore 106 provides an area inwhich a region of the adjustable loop 12 can be placed in the interiorof the anchor body 104. The bore 106 is sufficiently sized to preventpassage of the restriction element 28 therethrough. Generally, therestriction element 28 is larger than the bore 106 and cannot fittherein.

As shown in FIG. 5, the restriction element 28 can optionally beconnected to the adjustable loop 12 to further secure the adjustableloop 12 in the anchor 100. In such embodiments, the restriction element28 can be attached to the adjusting arm 16. The adjusting arm 16 can besewn or knotted into the restriction element to create a bridge orpassage across the proximal end of the anchor 100. The adjusting arm 16can also be passed through the adjustable loop 12 to interlace theadjusting arm 16 and the adjustable loop 12. In either such embodiment,the adjustable loop is further secured to the anchor 100.

The bore 106 is connected to a suture-receiving channel 108 with theport 110. The suture-receiving channel 108 is located on an exteriorsurface of the anchor body 104. The suture-receiving channel 108provides an area in which a region of the adjustable loop 12 canoptionally be placed on the exterior of the anchor body 104 withoutdamaging the flexible construct 10.

The port 110 connecting the suture-receiving channel 108 and theinterior bore 106 is generally perpendicular to at least one of thesuture-receiving channel 108 and the interior bore 106. The port 110provides the communication between the inside of the anchor (interiorbore 106) and the outside of the anchor (suture-receiving channel 108).The port 110 is sized to receive the adjustable loop 12. As shown, theport 110 and the external suture-receiving channel 108 partially extendinto the tip 102 and provide a break in the threading 112. The port 110can have the same diameter as the interior bore 106. In variousembodiments, the port 110 diameter, the interior bore 106 diameter, andthe cross-section of the suture-receiving channel 108 are the same. Theanchor 100 is stable and will not toggle when stress is placed on theanchor 100.

The suture-receiving channel 108 and the bore 106 are considered to beoffset or asymmetrical due to the adjustable loop 12 being partlyreceived in the interior of the anchor body 104 at the bore 106 andpartly received in the exterior of the anchor body 104 at thesuture-receiving channel 108. The combination and arrangement of thebore 106, the suture-receiving channel 108, and the port 110 form acontinuous track or loop around which the adjustable loop 12 can bewrapped. In various embodiments, the passage 14 can be sized to belonger than the track or loop. This allows for radially compression ortensioning of the passage 14 using the anchor 100 and thereby preventsmovement of the adjustable loop 12.

The asymmetric suture anchor 100 can include a proximal end groove 114to receive the suture and provides a surface upon which the restrictionelement 28 abuts. The proximal end groove 114 is in communication withthe opening at the proximal end of the anchor body 104.

The proximal end of the asymmetric suture anchor 100 also includes adriver-engaging region 116, such as those detailed earlier herein.Particular to the asymmetric anchor, the proximal end groove 114 can beprovided with a key 118, depicted as inwardly curving shapes which willbe axially received in the mating female driver.

Although the various embodiments detailed herein are used in connectionwith the asymmetric suture anchor 100, it is understood that any otheranchor or screw can be used in connection with the adjustable loop 12.Suitable anchors can include an interior bore or opening in which tohouse the adjustable loop 12 and/or include features to protect theflexible construct 10.

Referring to FIGS. 6 and 7, the anchor 100 and the adjustable loop 12combination is mated or connected to a driver 200. The driver 200includes a handle 202, an adjusting arm receptacle 204, an adjustableloop mount 206, and an elongated, hollow shaft 208.

The handle 202 is located at the driver first proximal end 210. Thehandle 202 is partially hollow and is in communication with the shaft208 at the shaft first proximal end 212 to facilitate passage of theadjusting arm 16 from the proximal end groove 114 of the anchor, downthrough the shaft 208, and out of the adjusting arm receptacle 204 onthe handle 202. The handle 202 further includes the adjustable loopmount 206 to secure the adjustable loop 12 such that advancement of thedriver 200 having the anchor 100 thereon through the cannula does notunintentionally move the adjustable loop 12.

To connect the driver 200, the anchor 100, and the flexible construct10, the adjustable loop 12 is passed through the bore 106 of the anchor100. The restriction element 28 is arranged to contact the proximal endgroove 114. The adjusting arm 16 is extended through the hollow shaft208, passed through the handle 202, and passed through the adjusting armreceptacle 204. The anchor 100 is oriented in close proximity to asecond distal end 214 of the shaft 208. Next, the adjustable loop 12 isdirected through the external suture-receiving channel 108 of the anchor100 and out of the port 110. The driver-engaging feature 118 of theanchor 100 is then connected to the mated feature on the shaft seconddistal end 214. The adjustable loop 12 can be aligned adjacent to theexterior of the shaft 208 to extend the adjustable loop 12 to theadjustable loop mount 206. In embodiments employing a restrictionelement 28, the restriction element 28 can be sized to prevent passageof the restriction element through the shaft 208.

Next, the adjustable loop 12 can be removably fixed or connected to theadjustable loop mount 206. The adjustable loop mount 206 keeps theflexible construct 10 in proper alignment with the shaft 208 such thatadvancement of the driver 200 having the anchor 100 and flexibleconstruct 10 thereon, through a cannula 216 does not unintentionallymove the flexible construct 10. Attaching the adjustable loop 12 to theadjustable loop mount 206 provides compression of the passage 14 andthereby restricts movement of the adjustable loop 12 in the directionopposite to arrow A of FIGS. 3A and 3B. When the adjustable loop 12 isdisengaged from the adjustable loop mount 206, moving the adjusting arm16 causes a reduction in the size of the adjustable loop 12. In variousembodiments, the adjustable loop 12 need not be mounted to theadjustable loop mount 206.

The tension can be maintained on the adjusting arm 16 by containing theadjusting arm 16 in the adjusting arm receptacle 204 or by othersuitable means. As long as tension is maintained on the adjusting arm 16(for example, via the adjusting arm receptacle 204) and the adjustableloop 12 (for example, via the adjustable loop mount 206), the flexibleconstruct 10 will not move while on the driver.

In various embodiments, the flexible construct 10 is used to fix adefect where there is a need to fix a soft tissue or implant to a bone.The flexible construct 10 and surgical techniques detailed herein can beused with various repairs of the shoulder, wrist, hand, ankle, foot,elbow, knee, or hip as non-limiting examples. Exemplary repairs includeBankart Repair, SLAP Repair, Acromioclavicular separation, rotator cuffrepair, capsule repair or capsulolabral reconstruction, bicepstenodesis, or deltoid repair of the shoulder; scapholunate ligamentreconstruction or ulnar radial collateral ligament reconstruction of thewrist or hand; lateral stabilization, medial stabilization, Achillestendon repair and reconstruction, halux valgus reconstruction, midfootreconstruction, and forefoot reconstruction of the ankle or foot;lateral epicondylitis (tennis elbow) repair, ulnar or radial collateralligament reconstruction, and biceps tendon reconstruction of the elbow;and extra-capsular repair, medial collateral ligament repair, lateralcollateral ligament repair, posterior oblique ligament repair, jointcapsule closure, iliotibial band tenodesis reconstruction, patellarrealignment and repair, patellar ligament and tendon repair, and vastusmedialis obliquus muscle advancement.

Referring to FIGS. 8A through 8D, methods of repairing a soft tissuedefect, such as a cartilage defect are provided. The adjustable loop 12is offset in the bore 106 of the asymmetric suture anchor 100 andaffixed to the driver 200 as detailed above. The adjustable loop 12 isreleased from the adjustable loop mount 206, if used, and the assemblyis placed in the cannula 216 at the defect site 300.

The adjustable loop 12 is then passed through the cartilage 302 as shownin FIG. 8B. The adjustable loop 12 can be passed through the cartilage302 by piercing a hole in the cartilage prior to passing the suturetherethrough. This can be performed with a separate needle, a needlethat is removably attached to the adjustable suture loop 12 or,depending on the fastener used, with a tip of the fastener. Any suitablesuture passer or other device can also be used to pass the adjustableloop 12 through the cartilage 302 such as those known in the art as“bird beak” passers or suture lariats. Two devices useful for passingthe suture include those sold under the tradenames SpeedPass andArthroPass, both made by Biomet Sports Medicine, Inc. of Warsaw, Ind. Afront portion 30 of the adjustable loop is passed through and protrudesfrom the cartilage 302.

The front portion 30 is lengthened (or further pulled through thecartilage 302) to provide an area in which to fold the adjustable loop12 upon itself. The front portion 30 is wrapped around the anchor 100 toform an S-shape which spans between the tissue and the anchor 100. Theanchor 100 is then passed back through the adjustable loop 12 as shownin FIG. 8C. This wrapping or doubling of the adjustable loop 12 providesa region in which the tissue is compressed.

The anchor 100 is then placed in a pre-drilled hole 304 in an adjacentbone 306 as shown in FIG. 8D. The threads 112 secure the anchor 100 inthe bone hole 304. The driver 200 can be removed once the anchor 100 issecured in the bone 306. This can be performed prior to or after thesuture is tightened down against the tissue.

Next, the adjusting arm 16 is engaged to reduce the size of theadjustable loop 12. The restriction element 28 keeps the adjustable loop12 in place on the anchor 100 and prevents retreat of the adjustableloop 12 through the shaft 208. When the adjusting arm 16 is advancedsufficiently far to provide the appropriate compression to the cartilage302 and fix the cartilage 302 at the defect site 300, the ends of theadjusting arm 16 can be removed as shown in FIG. 8E.

At least a portion of the proximal end of the anchor 100 is in veryclose proximity to the cartilage 302 or abuts the cartilage 302, therebyenhancing the fixation of the cartilage 302 to the bone 306. In variousembodiments, the suture-receiving channel 108 of the anchor can abut thecartilage 302 to minimize the length of suture 18 that remains betweenthe beginning of the available or suturable suture in the bone hole 304and the cartilage 302 or the other tissue to be secured. When the offsetor channel 108 area of the anchor body 104 abuts the defect site 300,the repair is stronger due to the ability to more tightly secure thetissue to the underlying bone 306 and the ability to minimize the gap orlag between the anchor body 104 and the tissue.

Such embodiments where the proximity between the tissue and the anchor100 is optimized are particularly useful in repairing certain softtissue defects, for example, a labral tear. The anchor body proximal endwould abut the labrum and provide strong attachment and promote healingof the labral tear and restore strength to the shoulder or the hip, forexample.

The above-mentioned repair techniques can be used for any orthopedicrepair including cartilage repair, ligament repair, or tendon repair, orany other orthopedic repair. The repair can be with an articularorthopedic surface or a non-articular and/or non-orthopedic surface.

Referring to FIGS. 9A through 9D, the present teachings also providesurgical methods where multiple flexible constructs 10 and 10′ areincorporated with multiple suture anchors 100 and 100′. To start, afirst anchor 100 is inserted as described above herein. Prior toremoving the first shaft 208 of the first driver 200, the second loop12′ is passed over the first shaft 208 as shown in FIG. 9A. Next, thefirst shaft 208 and the first driver 200 are then removed from thedefect site 300. The second anchor 100′ is then passed through the firstloop 12 again to interlace the adjustable loops 12 and 12′ as shown inFIG. 9B.

The second anchor 100′ is then secured through the tissue 302 and intothe bone 306. The first adjusting arm 16 and the second adjusting arm16′ are then engaged to cause the respective loops to reduce in size andform a link or bridge 400 of interlaced adjustable loops 12 and 12′between the first anchor 100 and the second anchor 100′. After theadjusting arms 16 and 16′ are engaged to the correct distance to reducethe respective adjustable loops and provide the appropriate amount oftissue compression and securing at the defect site 300, the adjustingarms 16 and 16′ can be optionally cut. There is no need for the surgeonto tie a knot as the interlaced and compressed loops provide the tissuefixation.

These surgical methods can be expanded to include a plurality ofadjustable loops and a plurality of suture anchors. In such embodiments,the anchors are inserted in succession as detailed above. Eachsubsequent anchor is then wrapped through the adjustable loop of anyprior anchor and then inserted into the tissue. The respective adjustingarms are then engaged advanced to create a larger interlaced bridgesystem.

The description of the present teachings is merely exemplary in natureand, thus, variations that do not depart from the gist of the presentteachings are intended to be within the scope of the present teachings.Such variations are not to be regarded as a departure from the spiritand scope of the present teachings.

What is claimed is:
 1. A suture anchor assembly, comprising: an anchorfor insertion into a hole in a bone, the anchor having a longitudinalaxis that extends between a proximal end and a distal end of the anchor,the anchor including a first opening in the proximal end of the anchorwhich leads to a longitudinal interior bore in the anchor, the anchorfurther including a second opening in a side wall of the anchor whichleads to a transverse passage in the anchor, the transverse passageproximate the distal end of the anchor and connecting the longitudinalinterior bore in the anchor to a longitudinal exterior channel in theanchor that extends along an outer surface of the anchor; and anadjustable suture construct that includes a suture with a first free endthat passes through a first longitudinal passage in the suture to form afirst adjustable loop, wherein the adjustable suture construct iscoupled to the anchor such that the first longitudinal passage in thesuture: (i) extends along the longitudinal interior bore; (ii) passesthrough the transverse passage; (iii) exits the anchor through thesecond opening in the side wall of the anchor; and (iv) extends alongthe outer surface of the anchor in the longitudinal exterior channel inthe anchor, wherein the first longitudinal passage in the sutureprotrudes from the second opening in the side wall of the anchor suchthat the first adjustable loop extends away from the second opening. 2.The suture anchor assembly of claim 1, wherein the first longitudinalpassage in the suture extends along the entirety of the longitudinalinterior bore in the anchor.
 3. The suture anchor assembly of claim 1further comprising a driver carrying the anchor.
 4. The suture anchorassembly of claim 3, wherein the driver includes an adjustable loopmount to which the first adjustable loop is removeably fixed.
 5. Thesuture anchor assembly of claim 4, wherein the first adjustable loopbeing removeably fixed to the adjustable loop mount includes a portionof the first adjustable loop being positioned around the adjustable loopmount.
 6. The suture anchor assembly of claim 1, wherein the entirety ofthe first adjustable loop is positioned outside the anchor.
 7. Thesuture anchor assembly of claim 1, wherein at least part of the firstadjustable loop is positioned along the outer surface of the anchor inthe longitudinal exterior channel in the anchor.
 8. The suture anchorassembly of claim 1, wherein the first free end of the suture extendsaway from the first opening in the proximal end of the anchor.
 9. Asuture anchor assembly, comprising: an anchor for insertion into a holein a bone, the anchor having a longitudinal axis that extends between aproximal end and a distal end of the anchor, the anchor including afirst opening in the proximal end of the anchor which leads to alongitudinal interior bore in the anchor, the anchor further including asecond opening in a side wall of the anchor which leads to a transversepassage in the anchor, the transverse passage proximate the distal endof the anchor and connecting the longitudinal interior bore in theanchor to a longitudinal exterior channel in the anchor that extendsalong an outer surface of the anchor; and an adjustable suture constructcoupled to the anchor, the adjustable suture construct including asuture with a first free end that passes through a first longitudinalpassage in the suture to form a first adjustable loop, wherein theadjustable suture construct being coupled to the anchor includes theadjustable suture construct extending through the longitudinal interiorbore in the anchor with the first adjustable loop extending away fromthe second opening in the side wall of the anchor and with the firstfree end of the suture extending away from the first opening in theproximal end of the anchor such that the first free end can be pulled toa reduce a size of the first adjustable loop, wherein the firstlongitudinal passage in the suture protrudes from the second opening inthe side wall of the anchor with at least part of the first adjustableloop being positioned along the outer surface of the anchor in thelongitudinal exterior channel in the anchor.
 10. The suture anchorassembly of claim 9, wherein the entirety of the first adjustable loopis positioned outside the anchor.
 11. The suture anchor assembly ofclaim 9, wherein the first longitudinal passage in the suture extendsalong the entirety of the longitudinal interior bore in the anchor. 12.The suture anchor assembly of claim 11, wherein the first longitudinalpassage in the suture: (i) extends along the longitudinal interior bore;(ii) passes through the transverse passage; (iii) exits the anchorthrough the second opening in the side wall of the anchor; and (iv)extends along the outer surface of the anchor in the longitudinalexterior channel in the anchor.
 13. The suture anchor assembly of claim9 further comprising a driver carrying the anchor.
 14. The suture anchorassembly of claim 13, wherein the driver includes an adjustable loopmount to which the first adjustable loop is removeably fixed.